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Biomedical subjects

D L Rollins

Publications and source records attributed to D L Rollins.

54 records · Page 3Linked to original sources
PubMed1989

The in situ bypass above the knee.

The anatomical location of the saphenous vein in the distal thigh allows for construction of an in situ bypass to the above-knee popliteal artery. The authors have performed over 1400 in situ bypasses in the past 10 years. Forty-three of these have been to the above-knee popliteal artery. Thirty-three bypasses were performed for limb threatening ischemia, seven for disabling claudication and three for microemboli. Mean patient age was 67 years, 51% were males, 44% had diabetes mellitus, and 93% smoked. Grafts were followed from one to 108 months. The cumulative patency rate at two years was 90% and at four years 77%. Patency rates compare favorably to those of femoral-to-above-knee popliteal bypasses constructed using reversed saphenous vein or polytetrafluoroethylene. The authors found that the in situ femoral-to-above-knee popliteal bypass is a technically easy procedure requiring short operative times and has a low morbidity rate. In those select patients in whom a femoral-to-above-knee bypass is the procedure of choice the in situ bypass should be considered.

Adult↗
PubMed1988

Origin of deep vein thrombi in an ambulatory population.

Eighty symptomatic ambulatory outpatients with acute deep vein thrombosis were evaluated with ascending contrast venography and ultrasonic imaging to determine the origin and distribution of thrombosis and to analyze clinical risk factors. Isolated calf vein thrombosis was present in 42.5 percent of the limbs, combined calf and proximal deep vein thrombosis in 47.5 percent, and isolated proximal thrombosis in 10 percent of the limbs. Discontinuity of thrombus was present in 55 percent, whereas 45 percent exhibited a continuous column of thrombus. The results of this study indicate that in the ambulatory outpatient population, acute deep vein thrombosis begins segmentally in the calf and proximal vessels and frequently coalesces into a continuous column of thrombus over several days. We believe that all cases of acute deep vein thrombosis should be treated and patients with evidence of previous acute deep vein thrombosis should be closely monitored for possible recurrences.

Adult↗
PubMed1988

The use of split-thickness skin as an autogenous arterial conduit.

Eight mongrel dogs were anesthetized using general anesthesia, and graft consisting of split-thickness skin obtained from their abdomen was devised and inserted in each of their infrarenal aortas. Six of the grafts were reinforced with meshed polytetrafluoroethylene (PTFE) as an outer layer to prevent potential aneurysmal dilatation of the skin graft. None of the dogs received aspirin at any time. The dogs were sacrificed at one, four, and six weeks. The grafts were examined with light microscopy and three of them were analyzed with scanning electron microscope. All grafts remained patent and none formed aneurysmal dilatations. None of the dogs developed infections or aortoenteric fistulas. Of the three grafts that showed thrombus-free areas, all were oriented with the epidermis facing the lumen. The three grafts where the epidermis formed the external surface did not degenerate in any area. Endothelium-like cells continuous with the host vessel were present on all grafts at 4 and 6 weeks by light or scanning electron microscopy. Preliminary data from this study indicated that split-thickness skin may be a suitable arterial conduit. Even if it does not prove to have long-term patency rates, it may be a suitable temporary conduit until infections resolve and synthetic prostheses can be reinserted.

Animals↗
PubMed1988

Progress in the diagnosis of deep venous thrombosis: the efficacy of real-time B-mode ultrasonic imaging.

Seventy-six limbs with clinically suspected acute deep venous thrombosis (DVT) were evaluated by means of ultrasonic imaging (UI) to define the ability of this technique to detect acute and chronic venous obstruction and to determine the origin and distribution of venous thrombi. UI was compared with ascending contrast phlebography in 46 limbs and was found to be 100% accurate in detecting both acute and chronic venous thrombosis. Overall, acute DVT was present in 63 of 76 limbs (83%) studied. Acute DVT was found in 24% and recurrent acute DVT in 76%. Our results indicate that although the calf veins are the most common site of involvement (89%), thrombi may frequently arise simultaneously in multiple anatomic sites. All limbs with recurrent acute DVT had evidence of previous calf thrombi but only 13% had previous proximal disease. This suggests that asymptomatic calf DVT is common and the prevalence of recurrent acute DVT is significantly greater than previously believed. We found UI is a practical, accurate, non-invasive method for investigating the pathogenesis of venous disease.

Acute Disease↗
PubMed1988

In situ tibial reconstruction. State-of-the-art or passing fancy.

To further evaluate the efficacy of in situ saphenous vein bypass, the authors have reviewed their experience with in situ bypass. Between October 1981 and December 1985, 120 in situ saphenous vein bypass were performed; 81 were to infrapopliteal vessels. All procedures were performed for limb salvage. The mean patient age was 74 years, and 74% were men, 57% had diabetes mellitus, 92% were smokers, and 72% had hypertension and/or coronary artery disease. All patients were evaluated by preoperative noninvasive testing and biplanar angiography. All procedures were performed by the valve incision technique. The vein utilization rate was 91%. Grafts were routinely placed into isolated tibial segments and foot vessels without evidence of a patent pedal arch. Follow-up information was obtained at 3-month intervals. Patency and limb salvage data were calculated by life-table analysis. The cumulative patency rates were 98% at 1 month, 88% at 12 months, and 82% at 50 months. These data demonstrate that the in situ bypass maintains an excellent patency rate and provides durable limb salvage.

Aged↗
PubMed1988

Venous thrombosis: the clinical problem.

Although the exact cause of DVT is not known, venous thrombosis and its sequelae remain important clinical problems. Pulmonary embolism is a significant cause of morbidity and mortality in the hospitalized population, and the postthrombotic syndrome affects a large portion of the general population. While specific screening tests are not readily available to detect those patients who are likely to develop DVT, certain clinical risk factors have been identified that predispose to thrombosis. These groups include patients undergoing a wide variety of surgical procedures, patients with cardiac disease or cancer, pregnant or postpartum women, and individuals with previous history of DVT. The diagnosis of thrombosis is based on clinical findings and must be confirmed with appropriate laboratory tests. While contrast venography remains the gold standard, noninvasive tests have become increasingly more accurate. The recent use of real-time B-mode ultrasonic imaging and duplex sonography for the diagnoses of DVT has been shown to be efficacious. The postthrombotic syndrome with its associated chronic pain and ulcerations remains a significant clinical problem. The general diagnosis of this condition is readily made on clinical grounds in the advanced state. However, exact knowledge of the location and cause of the venous pathology can only be obtained using objective diagnostic tests. Older noninvasive and invasive tests may diagnose the presence of venous obstruction, valvular incompetence, and also may document venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1987

Use of ultrasonic venography in the evaluation of venous valve function.

Forty healthy limbs and 31 limbs with suspected deep venous insufficiency were imaged with real-time B-mode ultrasound to determine valve location, anatomic characteristics, and function. Valve function was evaluated by comparison with Doppler ultrasonographic techniques, and the data clearly indicated that ultrasonic venography accurately localized and determined the extent of deep venous reflux. Ascending contrast venography was performed in 15 postphlebitic limbs for assessment of valve location. The results indicate that ultrasonic venography is a more accurate method for visualization of valves in this group of patients. Therefore, ultrasonographic imaging is a valuable technique for evaluating limbs with chronic venous insufficiency.

Humans↗
PubMed1986

Results of arterial reconstruction of the foot.

Sixty-five patients with critical ischemia required bypass to foot vessels. These procedures were performed by five different techniques: (1) femoral-foot bypass with in situ saphenous vein; (2) femoral-foot bypass with reversed autogenous saphenous vein; (3) femoral-foot bypass with polytetrafluoroethylene (PTFE); (4) popliteal-foot bypass with reversed autogenous saphenous vein; and (5) popliteal-foot bypass with PTFE. The two-year patency rate of femoral-foot bypass with in situ vein (96%) was significantly higher than femoral-foot bypass with reversed vein (42%), while both procedures demonstrated significantly higher patency than femoral-foot bypass with PTFE (0%). Popliteal-foot bypass with reversed vein (92%) was superior to both popliteal-foot bypass with PTFE (27%) and femoral-foot bypass with PTFE (0%). Femoral-foot bypass with in situ vein and popliteal-foot bypass with reversed vein have appreciably increased vein utilization, graft patency, and limb salvage.

Aged↗
PubMed1986

Efficacy of femorofemoral bypass for intermittent claudication. Clinical and hemodynamic assessment.

Twenty patients treated by femorofemoral bypass were retrospectively reviewed to determine if femorofemoral bypass was efficacious in the treatment of disabling claudication. The data have clearly demonstrated that two criteria are necessary for the successful outcome of femorofemoral bypass. First, the donor artery should be hemodynamically normal in order to support the recipient limb. This can be determined by either a normal treadmill exercise test result or by a normal preoperative intraarterial papaverine test result. Second, the patient's functional improvement will be dependent on the status of the runoff vessels in the recipient limb; therefore, many patients with patent superficial femoral and popliteal arteries will have excellent results (50 percent in this series), whereas those with occluded superficial femoral or popliteal arteries or both will have less improvement (40 percent in this series). Therefore, femorofemoral bypass should be used in the treatment of intermittent disabling claudication in the properly selected patient.

Aged↗
PubMed1986

Profundaplasty: its role in limb salvage.

The concept of the profunda artery as a collateral system is very useful in determining which patients may benefit from profundaplasty. When hemodynamic profunda stenosis is associated with combined aortoiliac and superficial femoral artery occlusive disease, profundaplasty as an adjunct to an arterial inflow procedure is highly successful. It is most efficacious when performed for disabling intermittent claudication and less successful for limb salvage indications. When isolated profundaplasty is performed for limb salvage, it may be an appropriate first procedure to heal ischemic ulcers and relieve rest pain. Ischemic gangrene is less frequently resolved and may require distal bypass. However, if the PPCI is low and/or the arteriographic appearance of the profunda system is favorable, then isolated profundaplasty may be successful. When limb salvage is precluded by extensive pedal necrosis or end-stage arterial disease, profundaplasty may provide effective perfusion of the knee joint so that a more functional below-knee amputation may be performed.

Amputation, Surgical↗
PubMed1985

Theophylline levels and clinical response in asthmatic adults receiving long-term Uniphyl.

Serum theophylline levels were measured in response to a single daily dose of Uniphyl in asthmatic adults who had previously received sustained-release theophylline preparations (usually Theo-Dur). Nine men and 20 women between the ages of 20 and 75 with a one-second forced expiratory volume (FEV1) of 30 to 75 percent of predicted and with at least 15 percent improvement in FEV1 following an inhaled beta-adrenergic agonist were enrolled. Patients with coexisting major organ system dysfunction were excluded. Maintenance prednisone in a dosage of 20 mg or less each morning and inhaled corticosteroids were allowed. The five-week study included a baseline week when the usual sustained-release theophylline was continued; theophylline blood levels were determined at six to 10 hours on the fifth day. Patients then switched to an equivalent dose of Uniphyl with single morning dosing. FEV1 and serum theophylline levels were observed weekly as during the baseline period. Side effects were carefully monitored throughout the study. Concurrent therapy included inhaled beta agonist in 28, oral prednisone in 11, and beclomethasone in one. Serum theophylline levels were remarkably stable during the four Uniphyl weeks and averaged 15 micrograms/ml. During this time, a small improvement in FEV1 occurred in weeks 2 and 4 (p less than 0.05). Only two patients reported substantial side effects--nervousness and slight morning dizziness--which responded to a downward adjustment of Uniphyl dosage. This study indicated that, in asthmatic patients previously receiving twice-daily theophylline therapy, switching to a daily single dose of Uniphyl maintained stable blood levels with a very low incidence of side effects and a modest improvement to FEV1 at the time of the normal serum peak of theophylline. This study suggests that Uniphyl can replace twice-daily theophylline dosing, which may result in improved patient compliance.

Adrenergic beta-Agonists↗
PubMed1985

Endarterectomized superficial femoral artery as an arterial patch.

Eighty-six patients underwent 90 profundaplasties for lower extremity ischemia using endarterectomized superficial femoral artery (ESFA) or vein as an arterial patch. Standard length profundaplasty was performed in 60 limbs and extended profundaplasty in 28. Seventy-two were performed for limb salvage and 18 for severe claudication. Fifty-four limbs underwent inflow reconstruction and profundaplasty, while 36 others had profundaplasty alone. Three-year cumulative patency rates were employed to compare the type of autogenous patch material to the profundaplasty length, operative indications, and procedures. In all groups, ESFA performed as well as vein. Endarterectomized superficial femoral artery patch angioplasty provides comparable long-term results to vein patch in patients undergoing profundaplasty, and demonstrates its durability as a vascular patch in situations where autogenous tissue is required or preferred while preserving the saphenous vein for later use.

Adult↗
PubMed1985

Ankle bypass: should we go the distance?

This report reviewed the results of 47 distal arterial reconstructions to or below the level of the malleolus. The operations were performed by the techniques of popliteal-to-distal bypass (20 procedures) and in situ bypass (27 procedures). Seventy-five percent of patients had gangrene of ischemic ulceration, and all procedures were performed for limb salvage. Seventy-three percent of all patients were diabetic. The patency rates for popliteal-to-distal bypass with reversed saphenous vein were 92 percent at 24 months and 57 percent at 60 months, with a limb salvage rate of 70 percent at 60 months; the patency rates for popliteal-to-distal bypass with PTFE were 53 percent at 12 months and 0 at 36 months, with a limb salvage rate of 53 percent at 36 months; and the patency rate for in situ saphenous vein bypass was 96 percent at 24 months, with a limb salvage rate of 80 percent at 24 months. Early results are promising for ankle bypass using the techniques of popliteal-to-distal and in situ bypass.

Aged↗
PubMed1985

Isolated profundaplasty for limb salvage.

Fifty-four patients underwent 56 profundaplasties for limb salvage. All had stenosis greater than 50% in diameter of the deep femoral artery and associated superficial femoral artery occlusive disease. After profundaplasty, ischemic ulcers healed in 9 of 17 (53%) patients. Rest pain was relieved in 6 of 19 (32%) and areas of ischemic necrosis healed in 7 of 20 (35%). Cumulative patency of the deep femoral artery was 49% at 3 years but fell to 21% at 5 years, whereas cumulative limb salvage was 49% and 36%, respectively. Eleven of the required 28 amputations were performed in the immediate postoperative period. Profundaplasty was used to lower the amputation level and preserve the knee joint in six patients. The other five early amputations occurred in severely ischemic limbs without distal vessels suitable for bypass. The profundaplasty remained patent in all 19 patients who underwent below-knee amputation and 16 (84%) became ambulatory with a prosthesis. Hemodynamic data provided by determination of the profundapopliteal collateral index predicted limb salvage in 10 of 11 (91%) of limbs when the index value was less than or equal to 0.19. Other clinical criteria, such as preoperative ankle-brachial index and the presence of diabetes mellitus, had no predictive value. Isolated profundaplasty for limb salvage is an effective first procedure for selected patients and provides a reasonable alternative to primary amputation or high-risk distal bypass. When amputation is inevitable, effective perfusion of the profunda femoris artery is essential for preservation of the knee joint and results in a high degree of functional rehabilitation.

Aged↗
PubMed1981

Fasciotomy: an appraisal of controversial issues.

Fourty-eight fasciotomies performed for conventional indications were analyzed, focusing primarily on the reliability of clinical diagnosis and the effectiveness of the operative technique. Decompression was accomplished immediately after hospital admission or arterial repair in 27 patients and deferred until the appearance of signs and symptoms in 21 others. Myoneural degeneration occurred in the delayed group only as a result of massive trauma or when obvious signs of compartment syndrome were ignored. A high index of suspicion and careful attention to clinical findings were reliable for establishing the diagnosis and indicating the timing of myofascial decompression. Tissue-pressure measurements were not used. The technique of four-compartment fasciotomy through a single lateral incision without fibulectomy was used in 21 limbs and compared with 18 four-compartment fasciotomies utilizing conventional methods. This procedure is rapid, simple, effective, and atraumatic and provides excellent exposure for direct visualization and selective decompression of all compartments and their individual muscles.

Compartment Syndromes↗
PubMed1981

Profundaplasty in perspective: limitations in the long-term management of limb ischemia.

The ultimate value of profundaplasty in the management of lower extremity ischemia was determined by multifactoral analysis of 239 operated limbs in 209 patients followed up to 110 months. In patients who underwent operation for claudication (n=83), patency without the need for subsequent revision or distal bypass was achieved in 77% at 5 years. By contrast, profundaplasty patency was maintained in only 23% of 154 limbs operated upon for salvage. The patient survival rate was 75% at 5 years and 56% at 7 years among the claudication group but only 29% at both 5 and 7 years in the limb salvage group. Of the 104 survivors in the limb salvage category, 43 required amputation, 79% within the first year, and 13 limbs were saved by additional revascularization procedures. Profundaplasty is a durable procedure for relief of claudication. However, it is significantly less effective in patients threatened with limb loss. When amputation is inevitable, effective profunda perfusion is essential for preservation of the knee joint.

Actuarial Analysis↗